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The Challenges of Pregnancy and Childbirth Among Women Who Were Not Infected with Ebola Virus During the 2013–2015 West African Epidemic

  • Regan H. Marsh
  • Katherine E. KralievitsEmail author
  • Gretchen Williams
  • Mohamed G. Sheku
  • Kerry L. Dierberg
  • Kathryn Barron
  • Paul E. Farmer
Chapter
Part of the Global Maternal and Child Health book series (GMCH)

Abstract

The 2013–2015 West African Ebola epidemic had a profound impact on the region’s fragile healthcare systems, leading to devastating outcomes for pregnant women. While the direct impact of Ebola virus disease on pregnant women is often clinically described, the second story of women without Ebola—and the worsening of their health outcomes, including increased maternal mortality—receives scant attention. Safe pregnancy and childbirth require access to functional health systems, making pregnant women among the most vulnerable in low-resource settings where health systems are weak. Prior to the Ebola epidemic, Liberia, Sierra Leone, and Guinea had some of the weakest health systems in the world, demonstrated by limited access to Emergency Obstetric Care (EmOC) services and high maternal mortality rates. In this context, with limited staff, stuff, space, and systems that comprise a functional health system, Ebola spread rapidly across the region—causing further devastation to essential functions and limiting essential services for pregnant women. In the context of the Ebola epidemic, outcomes for pregnant women without Ebola worsened, including less access to antenatal care, increased stigma, decreased facility-based deliveries, and decreased access to surgical delivery—leading to an increase in maternal mortality. We describe the efforts of Partners In Health, a nongovernmental organization, to strengthen health services delivery across the pillars of staff, stuff, space, and systems and to improve health outcomes for pregnant women during and following the epidemic.

Keywords

Health systems strengthening Pregnancy Maternal mortality West Africa Ebola Emergency obstetric care Antenatal care Human resources Infrastructure Supply chain Emergency response Uninfected women Partners In Health Epidemic response Healthcare system Caesarean section 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Regan H. Marsh
    • 1
    • 2
    • 3
  • Katherine E. Kralievits
    • 1
    • 3
    Email author
  • Gretchen Williams
    • 1
    • 3
  • Mohamed G. Sheku
    • 4
  • Kerry L. Dierberg
    • 1
    • 5
  • Kathryn Barron
    • 1
  • Paul E. Farmer
    • 1
    • 2
    • 3
  1. 1.Partners In HealthBostonUSA
  2. 2.Division of Global Health EquityBrigham and Women’s HospitalBostonUSA
  3. 3.Department of Global Health and Social MedicineHarvard Medical SchoolBostonUSA
  4. 4.Koidu Government HospitalKoiduSierra Leone
  5. 5.Division of Infectious Diseases and ImmunologyNew York University, School of MedicineNew YorkUSA

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